Bromelain-Based Debridement Versus Collagenase Ointment Debridement of Venous Leg Ulcers: Post Hoc Analysis of the ChronEx Trial

Background. A randomized controlled trial reported that bromelain-based enzymatic debridement (BBD) more effectively debrided and granulated venous leg ulcers (VLUs) compared with placebo (gel vehicle, hydrogel) and nonsurgical standard of care (including collagenase ointment [CO]). Objective. To assess the efficacy of BBD vs CO-based enzymatic debridement in VLUs during the ChronEx trial. Materials and Methods. The Wilcoxon exact test was used to compare the proportion of wounds in each group that achieved complete debridement and granulation at 2 weeks. Kaplan-Meier analysis was used to compare median times to complete debridement and granulation between groups. Results. Forty-six patients with 46 wounds were treated with BBD, and 8 were treated with CO. Twenty-nine wounds treated with BBD (63%; 95% CI, 48–77) were completely debrided within 2 weeks compared with none treated with CO (P = .001). Twenty-three wounds treated with BBD (50%; 95% CI, 35–65) achieved complete granulation by 2 weeks compared with none with CO (P = .015). The estimated median time to complete debridement and complete granulation, respectively, in the BBD group vs the CO group, respectively, were 9 days vs not achieved (P = .023), and 11 days vs not achieved (P = .014). The groups had comparable safety and pain profiles. Conclusion. BBD appears to be more effective and faster than CO in achieving complete debridement and granulation of VLUs as part of wound bed preparation.